MOONLIGHT MOUNTAIN RECOVERY, INC - NPI 1861983413 - Substance Abuse Rehabilitation Facility in Pocatello, ID

Q: What is Moonlight Mountain Recovery, Inc's NPI number?

The NPI number for Moonlight Mountain Recovery, Inc is 1861983413. It was assigned to this organization in the NPPES registry on May 18, 2018.

Q: What is Moonlight Mountain Recovery, Inc's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

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About Moonlight Mountain Recovery, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOONLIGHT MOUNTAIN RECOVERY, INC (NPI 1861983413) is a healthcare organization registered as a substance abuse rehabilitation facility in Pocatello, Idaho and active in the NPI registry since May 2018. The organization holds 2 active CLIA laboratory certificates and lists Wade Morden, Owner, as its authorized official.

NPPES Registry Identity

NPI1861983413

Entity TypeOrganization

Primary Taxonomy324500000X

Legal Business NameMOONLIGHT MOUNTAIN RECOVERY, INC

Location Address5230 W MOONLIGHT MINE RDPocatello, ID 83201-9013

Mailing Address2154 E 1340 SHeber City, UT 84032-1248

Phone(208) 505-9990

Organization SubpartNo

Authorized OfficialWade MordenOwner · (208) 505-9990

Enumeration DateMay 18, 2018

Last NPPES UpdateJanuary 13, 20212 updates tracked since enumeration

NPPES CertifiedJanuary 13, 2021

✔ NPI 1861983413 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities

Taxonomy Code324500000X

License✔ Licensed in ID · 1

Definition

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X

Also ListedClinic/Center · Adult Mental HealthTaxonomy 261QM0850X

Also ListedClinic/Center · Rehabilitation, Substance Use DisorderTaxonomy 261QR0405X

5230 W MOONLIGHT MINE RD, Pocatello, ID 83201

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Other Identifiers 1

Other1ID · Certificate Of Approval

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include PacificSource Health Plans.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D2179756

Moonlight Mountain Recovery Inc · Pocatello, ID

Active · expires Mar 1, 2028

CLIA Number13D2179756

Laboratory TypeResidential Treatement

Certificate Effective DateMarch 2, 2026

Certificate Expiration DateMarch 1, 2028

Laboratory DirectorWade Morden

Laboratory Phone(801) 915-8542

Laboratory LocationMoonlight Mountain Recovery Inc5230 W Moonlight Mine Rd, Pocatello, ID 83201

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 13D2268049

Moonlight Mountain Recovery · Pocatello, ID

Active · expires Sep 5, 2026

CLIA Number13D2268049

Laboratory TypeBehavior Health Php Iop

Certificate Effective DateSeptember 6, 2024

Certificate Expiration DateSeptember 5, 2026

Laboratory DirectorWade Morden

Laboratory Phone(801) 915-8542

Laboratory LocationMoonlight Mountain Recovery2500 S Fifth Ave Ste B, Pocatello, ID 83201

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ZACHARY KINNEY RECOVERY COACH

Peer Specialist

5230 W MOONLIGHT MINE RD
POCATELLO, ID 83201

Bannock County (208) 478-0219

EMILY K FLINT LPC

Counselor (Mental Health)

5230 W MOONLIGHT MINE RD
POCATELLO, ID 83201

Bannock County (208) 505-9990

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Moonlight Mountain Recovery, Inc's NPI number?

The NPI number for Moonlight Mountain Recovery, Inc is 1861983413. It was assigned to this organization in the NPPES registry on May 18, 2018.

Where is Moonlight Mountain Recovery, Inc located?

Moonlight Mountain Recovery, Inc is located at 5230 W Moonlight Mine Rd, Pocatello, ID 83201. The listed phone number is (208) 505-9990.

What is Moonlight Mountain Recovery, Inc's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

Does Moonlight Mountain Recovery, Inc hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Moonlight Mountain Recovery, Inc accept?

Health plans from PacificSource Health Plans list Moonlight Mountain Recovery, Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Moonlight Mountain Recovery, Inc was last updated on January 13, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.